{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:22:32Z","timestamp":1787750552568,"version":"build-2784847793"},"reference-count":29,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Rhodesiense human African trypanosomiasis\u00a0(rHAT) is an acute zoonotic infection that can rapidly progress to central nervous system (CNS) disease. As lumbar puncture is no longer routinely required for treatment selection, district hospitals need accessible measures associated with CNS inflammatory burden.\nAim:\u00a0This study aimed to evaluate routine admission clinical and laboratory measures as correlates of cerebrospinal-fluid white-cell count and to describe changes in this count during early hospital care.\nSetting:\u00a0The study was conducted at Rumphi District Hospital, a public secondary-level treatment facility serving rural communities in the Vwaza Marsh focus of northern Malawi.\nMethods:\u00a0We retrospectively studied patients aged \u2265 6 years with parasitological confirmed\u00a0rHAT\u00a0from 2012\u20132024. Cerebrospinal-fluid white-cell counts at admission and Day 11 were analysed using mixed-effects negative binomial regression, reporting adjusted incidence rate ratios (aIRRs) with 95% confidence intervals (CIs).\nResults:\u00a0Forty-three patients met the eligibility criteria; 43 contributed admission counts, and 42 contributed Day-11 counts. Day-11 cerebrospinal-fluid white-cell counts were 75% lower than admission counts (aIRR = 0.25, 95% CI: 0.14\u20130.45;\u00a0p\u00a0&lt; 0.001). Stage 2 disease was associated with a higher count than Stage 1 disease (aIRR = 4.23, 95% CI: 1.35\u201313.30;\u00a0p\u00a0= 0.013). Each 1 g\/dL increase in haemoglobin and albumin was associated with lower expected counts (haemoglobin aIRR = 0.83, 95% CI: 0.78\u20130.89;\u00a0p\u00a0&lt; 0.001; albumin aIRR = 0.70, 95% CI: 0.54\u20130.92;\u00a0p\u00a0= 0. 009).\nConclusion:\u00a0Lower haemoglobin and albumin were associated with greater cerebrospinal-fluid inflammation, which declined during early care. As accessible admission measures, they may support recognition, triage and monitoring of CNS burden in\u00a0rHAT, pending prospective diagnostic-accuracy validation before implementation.\nContribution:\u00a0This study links routine blood measures to cerebrospinal-fluid inflammation in\u00a0rHAT, informing prospective validation priorities.<\/jats:p>","DOI":"10.4102\/jphia.v17i1.1775","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:54:39Z","timestamp":1787748879000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Admission haemoglobin and albumin as correlates of central nervous system inflammation in rhodesiense human African trypanosomiasis at Rumphi District Hospital, Malawi"],"prefix":"10.4102","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5821-3844","authenticated-orcid":false,"given":"Westain T.","family":"Nyirenda","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05bk57929","id-type":"ROR","asserted-by":"publisher"}],"name":"Stellenbosch University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0146-3299","authenticated-orcid":false,"given":"Lovemore","family":"Mapahla","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05bk57929","id-type":"ROR","asserted-by":"publisher"}],"name":"Stellenbosch University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9303-9320","authenticated-orcid":false,"given":"Bonheur","family":"Dounebaine","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01d9dbd65","id-type":"ROR","asserted-by":"publisher"}],"name":"Africa Centres for Disease Control and Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5406-4171","authenticated-orcid":false,"given":"Nebiyu","family":"Dereje","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01d9dbd65","id-type":"ROR","asserted-by":"publisher"}],"name":"Africa Centres for Disease Control and Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2757-0663","authenticated-orcid":false,"given":"Peter S.","family":"Nyasulu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05bk57929","id-type":"ROR","asserted-by":"publisher"}],"name":"Stellenbosch University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref0","unstructured":"WHO. Trypanosomiasis, human African (sleeping sickness) [homepage on the Internet]. Geneva: WHO; 2023 [cited 2025 Aug 25]. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/trypanosomiasis-human-african-(sleeping-sickness)"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Franco JR, Priotto G, Paone M, et al. The elimination of human African trypanosomiasis: Monitoring progress towards the 2021\u20132030 WHO road map targets. PLoS Negl Trop Dis. 2024;18(4):e0012111. https:\/\/doi.org\/10.1371\/journal.pntd.0012111","DOI":"10.1371\/journal.pntd.0012111"},{"key":"ref2","unstructured":"WHO. Report of the fifth WHO stakeholders meeting on gambiense and rhodesiense human African trypanosomiasis elimination. Geneva: WHO; 2023."},{"key":"ref3","unstructured":"World Health Organization. Human African trypanosomiasis (T.b. rhodesiense), new cases, reported number [homepage on the Internet]. Global Health Observatory. Geneva: World Health Organization; 2026. [cited 2026 Jun] Available from: https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/number-of-new-reported-cases-of-human-african-trypanosomiasis-(t-b-rhodesiense)"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Seixas J, Atouguia J, Josenando T, et al. Clinical study on the melarsoprol-related encephalopathic syndrome: Risk factors and HLA association. Trop Med Infect Dis. 2020;5(1):5. https:\/\/doi.org\/10.3390\/tropicalmed5010005","DOI":"10.3390\/tropicalmed5010005"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Wendt EM, Tobolowsky FA, Priotto G, Franco JR, Chancey R. Notes from the field: Rhodesiense human African trypanosomiasis (sleeping sickness) in a traveler returning from Zimbabwe \u2013 United States, August 2024. MMWR Morb Mortal Wkly Rep. 2025;74(9):158\u2013159. https:\/\/doi.org\/10.15585\/mmwr.mm7409a3","DOI":"10.15585\/mmwr.mm7409a3"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Kuepfer I, Hhary EP, Allan M, Edielu A, Burri C, Blum JA. Clinical presentation of T.b. rhodesiense sleeping sickness in second stage patients from Tanzania and Uganda. PLoS Negl Trop Dis. 2011;5(3):e968. https:\/\/doi.org\/10.1371\/journal.pntd.0000968","DOI":"10.1371\/journal.pntd.0000968"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Kennedy PG. Clinical features, diagnosis, and treatment of human African trypanosomiasis (sleeping sickness). Lancet Neurol. 2013;12(2):186\u2013194. https:\/\/doi.org\/10.1016\/S1474-4422(12)70296-X","DOI":"10.1016\/S1474-4422(12)70296-X"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Frean J, Sieling W, Pahad H, Shoul E, Blumberg L. Clinical management of East African trypanosomiasis in South Africa: Lessons learned. Int J Infect Dis. 2018;75:101\u2013108. https:\/\/doi.org\/10.1016\/j.ijid.2018.08.012","DOI":"10.1016\/j.ijid.2018.08.012"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Eperon G, Schmid C, Loutan L, Chappuis F. Clinical presentation and treatment outcome of sleeping sickness in Sudanese pre-school children. Acta Trop. 2007;101(1):31\u201339. https:\/\/doi.org\/10.1016\/j.actatropica.2006.12.002","DOI":"10.1016\/j.actatropica.2006.12.002"},{"key":"ref10","unstructured":"WHO. Guidelines for the treatment of human African trypanosomiasis. Geneva: World Health Organization; 2024."},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Lindner AK, Lejon V, Barrett MP, et al. New WHO guidelines for treating rhodesiense human African trypanosomiasis: Expanded indications for fexinidazole and pentamidine. Lancet Infect Dis. 2025;25(2):e77\u2013e85. https:\/\/doi.org\/10.1016\/S1473-3099(24)00581-4","DOI":"10.1016\/S1473-3099(24)00581-4"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Stijlemans B, De Baetselier P, Magez S, Van Ginderachter JA, Trez CD. African trypanosomiasis-associated anemia: The contribution of the interplay between parasites and the mononuclear phagocyte system. Front Immunol. 2018;9:218. https:\/\/doi.org\/10.3389\/fimmu.2018.00218","DOI":"10.3389\/fimmu.2018.00218"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Lamour SD, Gomez-Romero M, Vorkas PA, et al. Discovery of infection associated metabolic markers in human African trypanosomiasis. PLoS Negl Trop Dis. 2015;9(10):e0004200. https:\/\/doi.org\/10.1371\/journal.pntd.0004200","DOI":"10.1371\/journal.pntd.0004200"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Musaya J, Matovu E, Senga E, Nyirenda M, Chisi J. AcSDKP is down-regulated in anaemia induced by Trypanosoma brucei infection in mice. Malawi Med J. 2017;29(3):259\u2013264. https:\/\/doi.org\/10.4314\/mmj.v29i3.6","DOI":"10.4314\/mmj.v29i3.6"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Lemerani M, Jumah F, Bessell P, Bi\u00e9ler S, Ndung\u2019u JM. Improved access to diagnostics for rhodesian sleeping sickness around a conservation area in Malawi results in earlier detection of cases and reduced mortality. J Epidemiol Glob Health. 2020;10(4):280\u2013287. https:\/\/doi.org\/10.2991\/jegh.k.200321.001","DOI":"10.2991\/jegh.k.200321.001"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Chimera ET, Fosgate GT, Etter EMC, Boulang\u00e9 A, Vorster I, Neves L. A one health investigation of pathogenic trypanosomes of cattle in Malawi. Prev Vet Med. 2021;188:105255. https:\/\/doi.org\/10.1016\/j.prevetmed.2020.105255","DOI":"10.1016\/j.prevetmed.2020.105255"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Heckman MG, Davis JM, Crowson CS. Post hoc power calculations: An inappropriate method for interpreting the findings of a research study. J Rheumatol. 2022;49(8):867\u2013870. https:\/\/doi.org\/10.3899\/jrheum.211115","DOI":"10.3899\/jrheum.211115"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Kennedy PG. Update on human African trypanosomiasis (sleeping sickness). J Neurol. 2019;266(9):2334\u20132337. https:\/\/doi.org\/10.1007\/s00415-019-09425-7","DOI":"10.1007\/s00415-019-09425-7"},{"key":"ref19","unstructured":"Rabe-hesketh S, Skrondal A. Multilevel and longitudinal modeling using Stata. 4th ed. College Station, TX: University of California\u2013Berkeley."},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Aguade AE, Begari A. Analysis of the mixed effects regression model for clustered count response data. ResearchGate; Durham, NC: Research Square, 2020.","DOI":"10.21203\/rs.3.rs-70873\/v1"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood. 2019;133(1):40\u201350. https:\/\/doi.org\/10.1182\/blood-2018-06-856500","DOI":"10.1182\/blood-2018-06-856500"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Kumesu VKB, Kalonji WM, Bardonneau C, et al. Safety and efficacy of oral fexinidazole in children with gambiense human African trypanosomiasis: A multicentre, single-arm, open-label, phase 2\u20133 trial. Lancet Glob Health. 2022;10(11):e1665\u2013e1674. https:\/\/doi.org\/10.1016\/S2214-109X(22)00338-2","DOI":"10.1016\/S2214-109X(22)00338-2"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Qahtani SYA, Alotaibi T, Aldossary TM, et al. The impact of hypoalbuminemia on inflammatory markers, serum creatinine, hemoglobin and outcome in critically ill patients with COVID-19 infection\u2013retrospective observation study. Acta Inform Med. 2025;33(2):96\u2013100. https:\/\/doi.org\/10.5455\/aim.2025.33.96-100","DOI":"10.5455\/aim.2025.33.96-100"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Rodgers J. Trypanosomiasis and the brain. Parasitology. 2010;137(14):1995\u20132006. https:\/\/doi.org\/10.1017\/S0031182009991806","DOI":"10.1017\/S0031182009991806"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Kennedy PGE, Rodgers J. Clinical and neuropathogenetic aspects of human African trypanosomiasis. Front Immunol. 2019;10:39. https:\/\/doi.org\/10.3389\/fimmu.2019.00039","DOI":"10.3389\/fimmu.2019.00039"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"\u00c1lvarez-Rodr\u00edguez A, Jin B-K, Radwanska M, Magez S. Recent progress in diagnosis and treatment of human African trypanosomiasis has made the elimination of this disease a realistic target by 2030. Front Med. 2022;9:1037094. https:\/\/doi.org\/10.3389\/fmed.2022.1037094","DOI":"10.3389\/fmed.2022.1037094"},{"key":"ref27","unstructured":"CDC. Clinical care of human African trypanosomiasis [homepage on the Internet]. CDC; 2024. [cited 2025 Nov] Available from: https:\/\/www.cdc.gov\/sleeping-sickness\/hcp\/clinical-care\/index.html"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Wiedermann CJ. Hypoalbuminemia as surrogate and culprit of infections. Int J Mol Sci. 2021;22(9):4496. https:\/\/doi.org\/10.3390\/ijms22094496","DOI":"10.3390\/ijms22094496"}],"container-title":["Journal of Public Health in Africa"],"original-title":[],"link":[{"URL":"https:\/\/publichealthinafrica.org\/index.php\/jphia\/article\/view\/1775\/3233","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:54:42Z","timestamp":1787748882000},"score":1,"resource":{"primary":{"URL":"https:\/\/publichealthinafrica.org\/index.php\/jphia\/article\/view\/1775"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/jphia.v17i1.1775","relation":{},"ISSN":["2038-9922","2038-9930"],"issn-type":[{"value":"2038-9922","type":"print"},{"value":"2038-9930","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"article-number":"a1775"}}